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New Study Suggests Hallucinations, Alone, Do Not Predict Onset of Schizophrenia

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Even after years of study and research, the diagnosis of schizophrenia in its early stages has remained a mystery “ from the appearance of its early symptoms to the development of the disorder in full form, it is quite difficult to point out when it spread its tentacles. A new research led by researchers at the UNC School of Medicine and the Renaissance Computing Institute (RENCI), the results of which were published online recently in the journal Schizophrenia Research has revealed that illogical thoughts as most predictive of schizophrenia risk. Surprisingly, it is also revealed that perceptual disturbances said to be the forerunners of hallucinations are not predictive, even though schizophrenia is characterized by full-blown hallucinations.

Diana Perkins, MD, a clinician and professor of psychiatry at the UNC School of Medicine and one of the first authors of the study said that the sooner people are identified of suffering from schizophrenia and the quicker they receive treatment, the better their prognosis. If people at high risk of psychosis can be identified, interventions can be developed to prevent the development of schizophrenia and the functional declines associated with it.

More than 3 million people in the United States suffer from schizophrenia. Late adolescence and early adulthood is the time when it begins and remains a chronic and disabling disorder for most patients. Psychosis refers to a group of symptoms, including paranoia, delusions (false beliefs), hallucinations, and disorganization of thought and behavior; more than 6 million people are said to experience it. Psychosis is a characteristic of schizophrenia even though it also occurs in people suffering from bipolar disorder or other medical conditions.

Mild psychosis-like symptoms are early warning signs of schizophrenia. About 15-20 percent of people who suffer from mild psychosis-like symptoms eventually develop schizophrenia or other disorders with full-blown psychosis. The current criteria for diagnosing attenuated psychosis is having one of these symptoms- illogical thoughts, disorganized thoughts, or frequent perceptual disturbances and severity to impact function.

For their study, Perkins and Jeffries examined what symptoms could predict psychosis over a two-year follow-up period in a group of 296 individuals diagnosed to be at high-risk for psychosis. Their study revealed that suspiciousness and unusual thoughts were the most predictive, and that difficulty with concentration further enhanced psychosis risk prediction.

Clark D. Jeffries, PhD, a scientist at RENCI and first author of the study said that identification of the most informative symptoms was performed with “stringent randomization tests. The investigators also validated these findings in a new cohort of 592 people with attenuated psychosis symptoms, confirming the findings. Unusual thought content and suspiciousness include a “feeling of being watched,” fixating on coincidences that aren’t actually connected, or finding “signs” in certain experiences or having a distorted sense of time. Difficulty concentration or focus refers to problems with distractibility and short-term memory. Reduced ideational richness typically refers to difficulty following conversations or engaging in abstract thinking.

It is surprising to note that perceptual disturbances “ for example: seeing shadows or hearing knocking noises with a sense that these experiences are “not real,” – were not predictive of psychosis. Such symptoms were common in those who suffer from psychosis, but they were not characteristic of the condition, which means that such symptoms were also equally common in those who did not develop psychosis.

Perkins opined that when assessing psychosis risk, this study reveals that a person's thought process must be emphasized rather than pinning on perceptual disturbances as a specific early warning sign as it may not be predictive of psychosis.